The patient was a 34 year old male successfully being treated for “mild depression” and “irritation”. The patient’s formula was modified every few weeks to maintain effectiveness and to address the normal fluctuations in his overall health presentation.
Brief Synopsis Of History Taken At Initial Visit:
The patient reports lifelong mild and chronic social anxiety, that has never been treated. Within his adult life the patient reports feeling “dysthymic”, or suffering from mild but chronic depression manifesting in this case as a limitation on the amount of joy that the patient feels.
The anxiety and dysthymia are complicated by chronic work stress. The patient is a Medical Doctor specializing in Emergency Medicine in California. Along with the understandable stress of the job, the patient stated that he becomes severely irritated with some of his more “career-oriented as opposed to patient-oriented” colleagues. He tends to keep “this irritation inside” due to a general tendency to avoid confrontation and for professional reasons.
The patient denies palpitations or any physical symptoms with anxiety.
It was observed that the patient sighed often. Upon questioning the patient confirmed a feeling of physical tension, including around the ribcage, due to stress and irritation.
In his professional opinion, the patient felt that his symptoms do not warrant prescription medication, although he believes he would be eligible for medications “given current prescription trends”.
Other notable symptoms reported include:
-Fatigue
-Constipation with stress, alternating with loose stools
-Poor Sleep, with trouble settling down at night
-Chronic headaches (2-3 x weekly, treated with ibuprofen)
-Night Sweats
-Frequent colds in the winter
-Chronically feeling cold
-Low back pain
Chinese Medicine Diagnostics
Pulse: Large vessel felt on palpation however actual pulse felt only with pressure. The pulse had a moderate force overall however there were some fluctuations in force as well as the overall form of the pulse.
Tongue: Pale body, Very thin Coat, Very thin central crack, no distended sublingual veins
Treatment: Tonify Qi, Regulate Qi, Benefit The Spirit
Herbal Formula:
The Patient was given Gui Pi Tang granulated herb extract. 1g of granules is roughly equivalent to 5g of raw herbs. The daily dosage provided was 12g per day.
Results:
Visit 2
After 3 weeks, the Pt. initially reported a noticeable and pleasant effect from the herbs though subtle. He reported that his mood to be more even. I gave the patient another 3 weeks of the same formula along with Jin Gui Shen Qi Wan in pill format to take when the patient went out in cold weather (It was winter).
Visit 3
At the next visit, 3 weeks later the patient reported a marked improvement in body temperature taking the Jin Gui Shen Qi Wan pills. For the first time in years the patient felt comfortable in cold weather. He no longer felt colder than other people.
The patient reports that he stopped taking the granular herbs for a few days to test whether or not they were really of benefit, and upon taking them again definitely noticed a difference and therefore desired to continue treatment.
While positive effects were being seen, greater benefit was desired on both the part of the practitioner and the patient therefore a new granular formula was derived. On inquiry the patient reported that the main issues he wished to address were “Dysthymia” and “Irritation”.
The patient purchased granulated herb extracts, 1g of granules is equivalent to approx. 5g of raw decocted herbs (5:1) unless otherwise noted in parentheses. Instructions: 7 grams in hot water, Twice Per Day. Daily Dosage:
Zhi Huang Qi 1.5g
Gan Mai Da Zao Tang 2g
He Huan Pi 2.5g
Suan Zao Ren(Chao) 2g
Long Yan Rou 1.5g
Gou Teng 2g
Yuan Zhi 1.5g
Visit 4
The patient reported a marked improvement with the formula change. The patient reported “having a bit more emotional pep”. The ability to experience positive emotions had increased slightly, as per the patient. The patient also used the herbs to give him clarity in the morning before work, noting that his morning dosage was the most important.
I left the patient on the previous formula for approx. 6 monthes. Aside from mood the patient did see some improvement in energy level, cessation of night sweats, and more regular bowel movements, etc.
Visit Five
After 6 months of brief check ins and refills we had a full visit. I asked whether the herbs had dropped off in their effectiveness the patient replied yes. At all visits before this, the patient reported generally doing well. I reviewed everything about the patient’s health with him to be sure nothing had changed. At that point irritation and constipation were primary symptoms. The patient also reported “cloudiness in the morning which was difficult to shake off”.
The patient purchased granulated herb extracts, 1g of granules is equivalent to approx. 5g of raw decocted herbs (5:1) unless otherwise noted in parentheses. Instructions: 7 grams in hot water, Twice Per Day. Daily Dosage:
Huang Qi (Sheng) 1.5g
Ling Zhi 1g
Bai Ren Shen 1g
Fu Shen 1g
Yuan Zhi 1g
Shi Chang Pu .5g
He Huan Pi 1g
Bai Ji Li 1.5g
Yu Jin 1g
Mei Gui Hua 1g
Dang Gui (Jiu Chao) 1g
Mai Men Dong 1.5g
Wu Wei Zi 1g
Vist 6
After 2 weeks on the previous formula, the patient reported that “he liked the way he felt” on these herbs. He reported more energy, less constraint. Constipation had subsided and bowel movements were regular. The patient reports that the “mild depression” had “lifted” and that he did not get stuck in those same emotions as he had previously.
The patient has continued to take herbs, reducing the dosage to once per day unless he feels 2 doses are needed. I change his herbs periodically as needed. Thus far the patient has been able to avoid taking prescription psych medications.
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